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* 1. Submitting this survey indicates your agreement to participate in this effort.  Are you completing this survey for yourself or are you helping someone complete this survey?

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* 2. How do you (the respondent) identify as?

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* 3. What is your racial or ethnic identity?

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* 4. What is your age (or the age of the person you are helping to complete this survey)?

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* 5. Please identify yourself in relation to disability status.  Check all that apply to you as the respondent or the person you are helping to fill out this survey.

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* 6. Please identify the type of disability that you primarily identify with.  Check all that apply.

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* 7. My identity(ies) makes it difficult for me to access understanding services and supports

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* 8. I feel like I belong in my community.

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* 9. I feel like Dubuque County is a friendly place that welcomes people with disabilities in the community at-large.

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* 10. Most days I feel respected and valued.

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* 11. I have a purpose in life.

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* 12. I mostly control what happens to me in my life.

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* 13. I have:

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* 14. In a typical week, which of the following forms of transportation do you use? (Check all that apply)

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* 15. Please describe any barriers you experience to accessing transportation.

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* 16. The resources and opportunities within Dubuque County gives me everything I need to have a successful competitive employment experience /career.

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* 17. The resources and opportunities within Dubuque County gives me everything I need to have a successful educational experience.

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* 18. The resources and opportunities within Dubuque County give me everything I need to be a meaningful part of the community.

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* 19. Please describe the most important issues relating to being a person with a disability or knowing a person with a disability living in Dubuque County (from your perspective).

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* 20. What resources or initiatives work well for people with disabilities in Dubuque County?

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* 21. What ideas do you have that could improve the quality of life for people with disabilities in Dubuque County?

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* 22. Below is a list of access rights detailed in the Americans with Disabilities Act that are often important to people with disabilities.  Please check any items on this chart that are important to you and rate them in terms of your satisfaction with what is offered in Dubuque County.

  I am satisfied with these resources I am not satisfied with these resources  I am unaware of these resources in Dubuque County
Access to Community Events, Dining, Social Activities
Competitive Employment
Public Services
Public Accommodations
Telecommunications/Internet
Transportation
Accessible Housing
Voting accessibility

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* 23. Below are key issues/efforts that are often important to people with disabilities.  Please check any items on this chart that are important to you and rate them in terms of your satisfaction with what is offered in Dubuque County.

  I am satisfied with these resources I am not satisfied with these resources I am unaware of these resources in Dubuque County
Facility-based transition support
Advocacy - people speaking with elected leaders and decision-makers to help them understand issues important to people with disabilities
Self Advocacy - people speaking up for themselves to get what they want
Peer support - people with lived experiences of disabilities helping others with disabilities
Information on disability-related resources
Services for people with disabilities
Services for people with mental health issues
Independent living training
Recreational opportunities
Social opportunities
Leadership opportunities
Family support

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* 24. How much does the availability of quality disability resources affect your ability to lead the life of your choice?  

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* 25. Is there anything else that you wish to share with the Dubuque County Board of Supervisors that was not covered in this survey?

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